Peroneus Longus Tendon vs Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction: A Comparative...

Background Anterior cruciate ligament (ACL) injury is a common orthopedic condition, particularly among young and physically active individuals. ACL reconstruction (ACLR) is widely performed to restore knee stability and improve functional outcomes. Hamstring tendon autografts are commonly used for reconstruction; however, concerns regarding inadequate graft diameter, delayed graft incorporation, and donor site morbidity have led to increasing interest in the peroneus longus tendon as an alternative graft source. The present study compared the functional outcomes and graft characteristics of hamstring tendon and peroneus longus tendon autografts in ACLR. Methods This observational comparative study was conducted in the Department of Orthopedics at Himalayan Institute of Medical Sciences, Dehradun, over a period of 12 months. A total of 80 patients with ACL rupture undergoing primary ACLR were included and divided equally into two groups. Group A included 40 patients reconstructed using hamstring tendon autografts, while Group B included 40 patients reconstructed using peroneus longus tendon autografts. Baseline demographic and clinical characteristics were recorded preoperatively. Functional outcomes were assessed using the Lysholm Knee Scoring Scale preoperatively and at six weeks and 12 weeks postoperatively. Final graft length and diameter were also compared between the groups. Results The mean age of patients was comparable between the hamstring and peroneus groups (30.35 ± 8.58 years vs 30.33 ± 9.35 years; p = 0.990). Male predominance was observed in both groups. The peroneus longus group demonstrated significantly greater graft length (8.37 ± 0.54 cm vs 8.00 ± 0.58 cm; p = 0.004) and graft diameter (7.73 ± 0.57 mm vs 7.40 ± 0.46 mm; p = 0.005) compared to the hamstring group. Preoperative Lysholm scores were comparable between groups (p = 0.410). However, significantly higher postoperative Lysholm scores were observed in the peroneus group at both six weeks (80.70 ± 5.98 vs 74.90 ± 8.11; p = 0.001) and 12 weeks (90.25 ± 3.46 vs 84.57 ± 4.97; p = 0.001). At 12-week follow-up, excellent functional outcomes were achieved in 40.0% of patients in the peroneus group compared to 7.5% in the hamstring group. Postoperative complications were minimal and comparable in both groups, with no cases of graft failure observed during the 12-week follow-up. Conclusions Peroneus longus tendon autograft demonstrated significantly greater graft dimensions and superior short-term functional outcomes compared with hamstring tendon autograft in ACLR. Both grafts were associated with low complication rates. The peroneus longus tendon may be considered a safe and effective alternative graft option for ACLR.